Hysterectomy and risk of cardiovascular disease: a population- based cohort study

This study of Ingelsson and colleagues examines the link between hysterectomy, bilateral oophorectomy and the risk of coronary heart disease and stroke.

The Swedish Inpatient and Cause of Death registers, which have completeness and accuracy exceeding 98-99%, were used to extract information about hysterectomy and bilateral oophorectomy. Women with a history of cardiovascular disease (CVD) or surgery for malignancy were excluded from the analysis. Information on age and socio-economic status (SES) was available from the registers but adjustment for other CVD risk factors was not possible.

181,441 women were eligible and were matched to women who had not had a hysterectomy but who were of the same age and from the same area of Sweden. Median follow-up was 10.4 years. Hazard ratios were calculated and adjusted for age, time and county + SES.

In women under the age of 50yrs, hysterectomy was associated with a higher risk of coronary events and stroke (HR 1.18, CI 1.13-1.23). Oophorectomy before the hysterectomy appeared to increase the risk still further (HR 2.22, CI 1.01-4.83). The same risk was not seen in women over the age of 50 at the time of the hysterectomy. Interference with ovarian blood supply and reduced hormone production after hysterectomy were considered plausible explanations for the CVD risk.

Limitations to the study include its observational nature. It was unable to adjust for a number of CVD risk factors, including weight, smoking and lipid profile, and may have missed cardiac events that did not require inpatient care. However, the size and accuracy of the registry data is impressive. The results are also comparable to other data showing higher CVD rates among women with an early surgically induced menopause. It suggests that we should weigh carefully the risks and benefits of hysterectomy in younger women.